The Cormac McCarthy Journal

Eastern State Hospital in Child of God

Born in Providence, Rhode Island, in 1933, McCarthy came to Knoxville when he was around four years old because his father had been hired as an attorney for the Tennessee Valley Authority. Until Cormac was about seven years old, the family lived—apart from a stint in the nation’s capital—in Knoxville homes just a few miles upstream and around a Tennessee River bend from Eastern State (Morgan, “McCarthy”). So, it is likely that, from time to time, the young Cormac would have glimpsed those wondrous fortress-like buildings.

McCarthy attended grade school in Knoxville, matriculated from Knoxville’s Catholic High School, and twice studied at the University of Tennessee in his adopted hometown (1951–52, 1957–60) (Luce 136–37). Between his years in the academy, he was in the Air Force. After distancing himself from the university for the second time and then living in Chicago for about two years, McCarthy returned to Tennessee and rented a small farmhouse in Sevier County, which would become the setting for most of Child of God. It is possible that he was still in East Tennessee when the Knoxville News-Sentinel ran a series of stories about deplorable conditions in Eastern State Hospital in March 1965—a fortuitous [End Page 74] date, as we will see.² After returning from travels in Europe in December 1967, McCarthy again lived near Knoxville, first in Rockford and then in Louisville, which was his home when the Knoxville Journal deemed Eastern State “a living grave” on January 25, 1971. At that time, McCarthy was at work on both Child of God and Suttree, as Fred Brown has noted (A11).³

It would not be surprising to find that a story in the Knoxville Journal informed Child of God, for it appears that media accounts of various kinds influenced that novel, as Luce has thoroughly chronicled. For example, beginning in April 1963, news reports of James Blevins—the voyeur of Lookout Mountain, who was eventually acquitted of murder—seem to have provided McCarthy with the pattern of “a plausible progression from voyeurism to murder,” for Lester Ballard begins “his progressive perversion as a peeping Tom” (138, 144). It also appears that the Blevins news reports supplied McCarthy with the seeds of his sympathetic portrayal of Ballard as ineffectual, fearful of mob violence, and perhaps even ashamed (Luce 140–44).

At midnight on 20 January 1971, and again the following midnight, Charles Appleton, a reporter for the Knoxville Journal, made unannounced visits to Eastern State Hospital. He was accompanied by a small group, which included another journalist, a state representative, and two attorneys. Each night, the group stayed for several hours and was given access to parts of the hospital that were usually off-limits to the public. In his first account of those visits, which appeared on 25 January, Appleton characterized the group’s findings as “shocking,” even though his paper “had been receiving frightening complaints about conditions [at Eastern State] for some time” (1–2). His story is strewn with anecdotes that bear a condemnatory tone, as this one does: “About 125 rooms are in medieval darkness, lacking even the convenience of overhead lights although they are in the same city that headquarters the Tennessee Valley Authority” (1).

In Child of God, McCarthy seems to have recycled numerous details from Appleton’s 25 January report. To see this, it is first necessary to recall McCarthy’s portrayal of Eastern State in that novel. Near the end of the story, after Lester Ballard returns himself to the Sevier County hospital, the main narrator tells us that Ballard

was never indicted for any crime. He was sent to the state hospital at Knoxville and there placed in a cage next door but one to a demented gentleman who used to open folks’ skulls and eat the brains inside with a spoon. Ballard saw him from time to time as they were taken out for airing but he had nothing to say to a crazy man and the crazy man had [End Page 75] long since gone mute with the enormity of his crimes. The hasp of his metal door was secured with a bent spoon and Ballard once asked if it were the same spoon the crazy man had used to eat the brains with but he got no answer.

He contracted pneumonia in April of 1965 and was transferred to the University Hospital where he was treated and apparently recovered. He was returned to the state hospital at Lyons View and two mornings later was found dead in the floor of his cage.

(193–94)

In characterizing the “demented gentleman,” his “crimes,” and “his metal door […] secured with a bent spoon,” it appears that McCarthy drew directly on Appleton’s 25 January story, which includes a photo of a metal door with a caption that reads: “A bent tablespoon secures the door of a patient in Eastern State Psychiatric Hospital suspected of bashing a man’s brain out and eating it” (1). Appleton also “observed a spoon in the latch of at least one other door in the hospital’s so-called ‘maximum security’ section” (1).

From the same story of 25 January, McCarthy could have also learned that Eastern State had long relied on the University Hospital to care for patients who fall ill, just as Lester Ballard does and is “transferred to the University Hospital” (193). Appleton writes: “More than a dozen patients have broken bones that have not been set because … the hospital owes University Hospital a bill in excess of $50,000 and does not wish to increase it” (1). However, Appleton also explains that, to some extent, Eastern State was still relying on the University Hospital, for, during the investigators’ initial visit, a patient experienced what appeared to be a heart attack and was taken by Eastern State’s ill-equipped ambulance to the University Hospital (2).

The extended passage above also suggests that Ballard and some of his fellow inmates are “taken out for airing” only “from time to time” (193). In other words, they are confined indoors—and probably to their “cages”—almost all of the time. This is another idea that McCarthy could have inferred from the 25 January account, in which Appleton notes the following consequence of understaffing: “A nurse charged with the care of some 200 patients in the West Wing of the Center Building had keys to only a few of the doors in her section and frankly admitted that a fire would claim two-thirds of her patients” (1). Missing keys seem to imply that patients stay locked—or otherwise “secured”—in their rooms.

Furthermore, notice that Ballard’s death is never explained medically, for “he was treated and apparently recovered” from pneumonia (193–94). In that vein, the 25 January story mentions that Eastern State had recently suffered [End Page 76] a very high death rate, and, for some of those deaths, the precise causes were unknown. Of Eastern State’s population of 2,400, Appleton writes, “two hundred thirty-seven patients died last year, according to state records, although investigators were told the average was more like two a day. Five patients died there about a year ago after their necks began swelling mysteriously and then they began bleeding internally. No medical explanation has been given for their deaths” (2). Additionally, the combination of missing keys and a very high patient-to-caregiver ratio would also make it likely that some dying patients—like Ballard—would go unattended and, instead, only be “found dead” eventually (194).

Finally, the “April of 1965” date of Ballard’s death is reminiscent of the Knoxville News-Sentinel’s series of stories in March 1965 about Eastern State’s horrific estate. For example, on 26 March 1965, Pete Prince reported that Eastern State was vastly understaffed, was constrained in its ability to offer therapy, and—as one official put it—“the vast majority” of its patients remained “cramped up in old buildings” (13). Of course, Ballard’s demise in “April of 1965” and the March 1965 appearance of those stories might be no more than coincidence. But perhaps McCarthy chose “April of 1965” deliberately to situate Ballard’s death in something like the grim environs that those articles describe. Either way, that shared chronology lends an extra layer of realism to Ballard’s death.

What significance might this brief and realistic portrayal of Eastern State Hospital have for our understanding of Child of God? Apparently, Ballard does not regard himself as “crazy,” as his somewhat comical attitude toward the brains-eating “demented gentleman” suggests: Ballard “had nothing to say to a crazy man” (193). Perhaps Ballard believes that he should not be confined to Eastern State. If so, might he be onto something—his many other confusions aside? Is Lester Ballard really so very different from the society that has exiled him? Vereen M. Bell has claimed that “no one in this community is even remotely like Lester” (56–57). However, as I have argued elsewhere,⁴ a close reading of the novel reveals that Ballard and his society bear striking resemblances. They are foolish, greedy, violent, grotesque, and much more. For example, Ballard harasses and abuses others (17–18, 117–18), but he is also harassed and abused (42–43, 52, 55–56). Furthermore, as Lang observes, both Ballard and an unnamed suitor are rejected by one of the dumpkeeper’s daughters, and Ballard joins an older man in cheating at a local fair (107). Additionally, no less than a Sevier County deputy is sympathetic to the extralegal tactics of the White Caps—a gang that, like Ballard, was notorious for mistreating women, stealing, and murdering (165). Furthermore, some of the townsfolk narrators claim that Ballard was made “crazy” by the death of a loved one, just as “old Gresham” was [End Page 77] (21–22). And just as Ballard mistreats one of his cows, the “Trantham boy” dealt harshly with his stubborn oxen (35–36). Jay Ellis also points out that, like his fellow prisoner in the county jail, Ballard is presented as a “fugitive from the ways of this world” (82). Ballard is also far from unique in his desire for young women and girls (26–27, 88), and neither is he alone in choosing to dwell underground (168). Ballard is not the only one guilty of mistreating corpses (21, 196), and even necrophilia is not unimaginable to some of Ballard’s peers, as Luce has noted (142). Given all of these similarities between Ballard and his society, his ostracism to Eastern State is somewhat suspicious. After so many parallels between Ballard and others in Sevier County, Ballard’s confinement to Eastern State can be seen as a very poignant means of questioning society’s basis for distinguishing so sharply between itself and its outcasts. In relationship to the same hospital, a similar theme emerges in Suttree.

While it is almost certain that the 25 January 1971 report in the Knoxville Journal influenced McCarthy’s depiction of Eastern State in Child of God, it is equally clear that that and other stories informed both the published text of Suttree and—in some outlandish ways—that novel’s unpublished “rescue” scene.

Eastern State Hospital in Suttree

Like Child of God, Suttree was informed by media reports. For example, as Wes Morgan has shown, to elaborate on what the narrator calls “a season of death and epidemic violence” (416), McCarthy drew on the Knoxville papers’ extensive coverage of criminal exploits between 1958 and 1960 and relocated some of them to the 1954 of that section of the novel (10–11). The narrator relates some of the events from that “season”: “Clarence Raby was shot to death by police on the courthouse lawn and Lonas Ray Caughorn lay three days and nights on the roof of the county jail among the gravels and tar and old nests of nighthawks until the search reckoned him escaped from the city” (416). As Morgan explains, this description of Raby’s death is generally accurate, while the characterization of Caughorn “seems to be entirely fictional,” though Caughorn was renowned for his prison escapes (10). Later in the same paragraph, the narrator even invokes “news in the papers. A young girl’s body buried under trash down by First Creek. Sprout Young, the Rattlesnake Daddy, indicted for the murder” (416). After surveying some of the “news in the papers” that informed those sentences, Morgan concludes: “Sprout Young, the Rattlesnake Daddy, was a real person who was indicted for the murder of a young girl found under trash near First Creek. Newspaper reports of the events match McCarthy’s brief description” (11). [End Page 78]

In light of McCarthy’s borrowing from news stories for the “season of death” paragraph that Morgan examines, we should not be startled to discover that McCarthy employed a similar technique elsewhere in Suttree.⁵ And that is precisely what we find beginning just fifteen pages later as Suttree visits a relative in Eastern State Hospital. That passage begins: “In the madhouse the walls reek with the odors of filth and terminal ills they’ve soaked up these hundred years. Stains from the rusted plumbing, the ordure slung by irate imbeciles. All this seeps back constantly above the smell of germicidal cleaning fluids” (431). These three sentences are packed with details that McCarthy could have drawn from the Knoxville Journal’s stories of late January 1971.

First, it is likely that the second sentence above—“Stains from the rusted plumbing, the ordure slung by irate imbeciles” (431)—was influenced by a photo caption and other text from the 25 January report. The photo shows a toilet that seems to bear stains both within and without, and its caption reads: “Patient bathroom facilities … are lacking sanitation, but not odor” (1). Later in the same story, Appleton notes that “bathroom facilities were observed dirty with no effort to remove the stains caused by urine and human excretion” and that “patients frequently urinate on the floor of their rooms and at the doorways” (2). All of this, Appleton writes, results in a noxious smell: “Some wards reeked with odor so strongly that it almost caused investigators to vomit” (2). Appleton’s phrase “reeked with odor” finds its echo—almost verbatim—in the first sentence of the relevant passage from Suttree, as quoted above: “the walls reek with the odors of filth and terminal ills they’ve soaked up these hundred years” (431). And even the last sentence in that passage from Suttree—“All this seeps back constantly above the smell of germicidal cleaning fluids” (431)—was probably influenced by Appleton’s story of 27 January 1971, in which he reports that “there are no cleaning rags on many wards” and “soap frequently runs out before the end of the month” (1). Then Appleton goes on to note that “only five gallons of disinfectant are provided every two weeks to clean seven wards with 80 patients in each ward. As a result odor permeates the hospital and clings to the clothing” (1).

As this scene from Suttree continues, the visitor enters

a room where the mad sat at their work. To Suttree they seemed like figures from a dream, something from the past, old drooling derelicts bent above their basketry, their fingerpaints or knitting. He’d never been among the certified and he was surprised to find them invested with a strange authority, like folk who’d had to do with death some way and had come back, something about them of survivors in a realm that all must reckon with soon or late. [End Page 79]

In the center of the room sat a nurse at a desk. She read the morning paper where the news was madder yet.

(431)

Until the last two sentences of this passage, the narrator is conveying how things “seemed” “to Suttree,” including Suttree’s assumption that all of the patients at Eastern State are “certified,” or “mad.” As Suttree crosses the room and approaches his great aunt, Alice McKellar, that assumption remains present: “He thought that he might know her in some way but age and madness had outdone all the work of likeness there had ever been” (431–32). However, as we will see, at the end of this scene, Suttree—and readers—are given reason to doubt that all at Eastern State are mentally ill. And we are prepared for that doubt by the end of the extended passage above, where the narrator remarks that a nurse “read the morning paper where the news was madder yet.” In other words, perhaps the world of Eastern State Hospital is not so different from the world beyond its gates, which is replete with “madness” of its own. That is, perhaps we are being asked to worry about the credibility of a distinction between “civilized” society and those it deems “mentally ill” or otherwise deviant. On the reading being advocated here, that worry is central to the significance of McCarthy’s use of Eastern State Hospital in both Suttree and Child of God.

In the passage above, Suttree observes “the mad […] at their work” (e.g., “basketry,” “fingerpaints,” “knitting”). But this is curiously inconsistent with Appleton’s own observations, as he reports in the Knoxville Journal on 26 January 1971: “There were no signs of therapy. Many patients sit for long hours without anything to do. This reporter saw no books and few televisions. A jukebox in the juvenile section was broken” (2). Furthermore, in that same story, Appleton refers to the oldest of Eastern State’s buildings as “built in 1884” (2), and, in the previous day’s article, he calls them “century-old” (1)—a description that, in 1971, would have been only thirteen years premature. However, when McCarthy wrote of the “hundred years” during which “the madhouse” walls absorbed “filth and terminal ills,” he seems to have borrowed Appleton’s “century-old” descriptor and relocated it to the 1955 of Suttree’s visit to Eastern State, rendering it a total of twenty-nine years premature (431). If these steps away from realism—small though they may be—were intentional, their value is not readily apparent.

During the conversation with his Aunt Alice, Suttree asks, “Do they treat you well?” And Alice responds, “Oh, a body ought not to complain,” suggesting that, in fact, she is not treated well (432). Alice does not elaborate, but Appleton’s stories of January 1971 could have supplied McCarthy with numerous reasons to suppose that Alice would have experienced poor care. Earlier, we noted Appleton’s observations that many patients had broken [End Page 80] bones that had not been set and that the facility maintained a very high patient-to-caregiver ratio. Regarding the latter, the 25 January story mentions that, each night that Appleton and his group visited, only 54 employees were on duty to care for 2,400 patients (1). That story also describes a consequence of overcrowding: “Beds in many wards are virtually touching, reportedly in violation of state law […]. Others are stuck in the hallways and 36 patients inhabit the drab auditorium” (1). The next day’s article cites a staff member’s opinion that “the food service had declined to the point that patients are not given adequate nourishment” (1). And the theme of overcrowding appears again: “Rooms are tiny, overcrowded and oppressing. Four and five patients sleep in a single room in some areas” (2). There, Appleton also remarks that the facility’s 2,400 patients are “about 700 more than recommended by the American Psychiatric Association for a hospital this size” (2). Little wonder, then, that, as Suttree prepares to leave his Aunt Alice, he surveys the abundance of human “wreckage” around him and ruminates: “What perverted instinct made folks group the mad together? So many” (434).

At last, it appears that Suttree begins to consider whether this hospital’s way of operating is justified. As he leaves, he might also start to wonder whether all of the men and women around him are truly “mentally ill”—just as Appleton reports on 27 January that, of Eastern State’s 2,400 patients, only “about 900 are considered psychiatric” (1)—for Suttree discovers the presence of his friend, Daddy Watson. “An old man in a striped railroader’s hat was holding a huge watch in his hand and following Suttree with his eyes as if he’d time him. Their eyes met across the dayroom and Suttree’s face drained to see the old man there and he almost said his name but he did not and he was soon out the door” (434). The previous winter, Suttree had been unable to locate Daddy Watson in his makeshift quarters in an old locomotive, so he went to see whether the ragman had news of the railroader. “Is he dead?” Suttree asks, and the ragman replies, “I dont know. I think they come and got him” (365). When Suttree asks whether he is talking about the police, the ragman says, “It might of been any of em. I reckon I’ll be next. You aint safe,” and Suttree concurs: “I’ll agree with that” (365). As their conversation continues, it is clear that Suttree identifies with outcasts like Daddy Watson and the ragman—one of this novel’s most obvious and persistent themes. Suttree praises the old man, telling him that he is “right,” and he goes on to declare of himself and his fellow exiles: “We’re all right.” But the ragman is not so sure: “We’re all fucked, said the ragman” (366). So, as Suttree leaves Eastern State with “face drained,” the ragman’s point might have just been made in another, powerful way: Given Daddy Watson’s presence in Eastern State, Suttree and his fellow outcasts are all in jeopardy. More [End Page 81] specifically, as Suttree leaves, he might be struck by the apparent arbitrariness of a social arrangement that would confine his friend to a mental hospital while permitting similar deviants—like Suttree himself—to roam freely. Perhaps a society so threatening and so confused really is “madder yet.”

The motif of a somewhat flimsy division between the “crazy” and the “sane” can also be found in a scene that was not included in the final text of Suttree. Once again, the setting and dialogue revolve around realistic—and comical—aspects of life at Eastern State Hospital. In this episode—which would have fallen between early-morning drinking at the Signal Café and late-night rampaging “at a roadhouse called the Indian Rock” (184)—J-Bone, the narrator tells us, wants to “rescue” a character named William C. Pathe “from the state mental hospital at Lyons View.”⁶ As J-Bone tries to convince Suttree to help him free Pathe, J-Bone insists that Pathe is “crazy.” Yet, when Suttree asks J-Bone why, then, he would want to liberate Pathe, J-Bone’s response implies that it goes without saying that Pathe’s confinement is out of place: “Hell, Sut. If we dont get him out who will?” Suttree agrees to help. They call Eastern State to alert Pathe that they are coming for him.

As Pathe hides behind a tree near the iron fence that encircles the hospital’s grounds, he sees a car with J-Bone, Suttree, and Cabbage inside. Pathe scales the fence, leaps onto the car, and climbs in. As the four drive away, they pass around a bottle of Early Times, and Pathe relates some of the sordid features of Eastern State. He cites the limited electricity and the poor diet, both of which Appleton mentions. But Pathe also shares this: “You never seen the like of rats. They brought three big old tomcats out there from the animal shelter and turned em loose and they never did see em again. They said they found one of em’s bones behind a cabinet in the kitchen. Looked like they’d been took apart and polished and put back.” Similarly, Appleton’s report of 25 January 1971, details the hospital’s extensive rat problem, noting that rats have been seen in practically every section of the enormous hospital, and investigators noticed “rat holes […] throughout the East and West Wings” (2). The rodents had been spotted inside linen closets, in “large electric toasters, on the milk machine table, on the food service area, in food storage rooms, under the main oven and under the stoves in the kitchen” (2). And in words that Pathe echoes, Appleton goes on to say that “the hospital reportedly obtained three cats from the Animal Shelter to take care of the rats, but hospital employees have not seen the cats lately and strongly suspect they have been eaten by the rats” (2).

In his account published the following day, Appleton remarks that “a patient could spend several days in Eastern State and never once see a psychiatrist. The national average, we were told, is for a patient to see a psychiatrist two minutes [End Page 82] a month. Even that is not maintained locally” (1–2). Similarly, Pathe tells his rescuers that “about once a month or so they’d send this doctor around from the State to make sure everbody was still crazy.” Later, Pathe offers his companions some advice: “Boys let me tell ye don’t ever get your ass in that joint back yonder. You aint crazy when you go in you will be when you get out.” As we have seen, Appleton’s stories offer numerous reasons to think that there might be something to Pathe’s contention: overcrowding, few caregivers, limited therapy, idleness, scarce and low-quality food, deplorable sanitation, poor pest control, and cramped sleeping conditions. To that list, we might add the opinion prevalent among Eastern State nurses—as Appleton writes on 26 January 1971—that the “Mental Health Coordinators” who “are given full responsibility for patient treatment” are, in fact, “unqualified lay people” (2). In light of all of these similarities, it is plausible to conclude that McCarthy drew on his reading of Appleton’s reports for his realistic portrayal of Eastern State in Suttree.

Finally, even the “rescue” of Pathe might have been inspired by another story in the Knoxville Journal—that of 16 February 1971, its headline reading: “ESH Patient Returned after Eventful ‘Joyride.’” It tells of a patient who had a habit of trying to escape by stealing vehicles left unattended on the grounds. However, unlike that patient’s flight, Pathe’s joyride does not end with his being “returned” to Eastern State. Instead, the group stops at a service station, where Pathe grabs the receiver from a man at a pay phone and turns an ordinary conversation into a hilarious crank call, “Suttree and Cabbage and J-Bone standing outside listening with enormous grins.” “Crazy” or not, Pathe proves himself to be one of the gang: “By ten oclock that night they were twelve or more. All good hearts from McAnally, one naturalized.” With Pathe seamlessly assimilated as a fellow “good heart,” it seems that J-Bone is vindicated in his distaste for the social partition that is Eastern State. In that way, had this unpublished scene made Suttree’s final cut, it would have complemented that novel’s later portrayal of Eastern State as the site of a questionable social distinction.

Conclusion

Charles Appleton’s report of 25 January 1971, in the Knoxville Journal begins: “A living grave into which society has dropped 2,400 mentally ill persons has been uncovered” (1). This article has argued that Appleton’s descriptions of Eastern State Hospital in that and subsequent stories very likely influenced Cormac McCarthy’s portrayals of the same hospital in Child of God and Suttree. Furthermore, perhaps like Appleton’s opening juxtaposition of “society” [End Page 83] and “mentally ill persons,” Eastern State seems to function in those novels as a further, specific means of casting doubt on the typical distinction between society and its many outcasts, including those persons it deems “insane”—a theme that McCarthy first probed by placing The Orchard Keeper’s Arthur Ownby in Eastern State. In that way, a state mental hospital that, at first glance, would appear to be little more than a background setting can be understood as fulfilling a more important role in a broader project shared by Child of God, Suttree, and perhaps even The Orchard Keeper—a reconsideration of the alleged differences between a society’s mainstream and persons subsisting at its margins.